The Impact of Opening a Private Hospital Emergency Department on the Hospital and Patient Characteristics

Abstract

Introduction: Australian public hospital emergency departments (EDs) are under increasing pressure with higher patient volumes, failure to meet triage target times and increased ambulance wait times.  Further, there is limited literature exploring how the opening of an ED affects Australian hospitals. This study focuses on Hollywood Private Hospital (HPH), a large private hospital in Western Australian which opened their ED in November 2021. The research aimed to examine how the introduction of the ED influenced the hospital’s service demands and resourcing.

Method: This study investigated hospital inpatient characteristics including admissions, clinical deterioration episodes, deaths, after-hours theatre activity and companion care hours.  The investigation compared the periods 01 January to 30 June 2021 (2021) and 01 January to 30 June 2022 (2022) to identify differences pre and post the ED opening.

Results: Overall, the number of inpatient admissions was similar from 2021 to 2022 (31,061 and 31,706 respectively). However, there was a statistically significant change in the admission type with a decrease in elective admissions (925.2 in 2021 and 880.4 in 2022 (p<.001)) and an increase in emergency admissions (67.4 in 2021 and 111.1 in 2022 (p<.001)). A significantly higher incidence rate of rapid response calls was reported in 2022 compared to 2021 (p=.043), nonetheless there was no difference in the incidence rates of cardiac arrest (p=.445), code blacks (p=.600) or patient deaths (p=.880). From 2021 to 2022 there was an increase in both after-hours theatre procedures (6.6% to 9.0%; χ²=50.9 p<.001) and median companion care hours (Md = 32.5 to Md=56.3; U=2.3, p=.021).

Implications: The opening of the HPH ED resulted in increased after-hours and emergency related admissions with a co-occurring increase on companion hours.  These impacts necessitate significant resourcing investment such as revised staffing models and rosters, additional recruitment, and change management.